Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 2081P2900X | Physical Medicine & Rehabilitation | Pain Medicine | 35.057402 | OHIO | No |
| 2 | 2081P2900X | Physical Medicine & Rehabilitation | Pain Medicine | MD034146E | PENNSYLVANIA | No |
| 3 | 2081P2900X | Physical Medicine & Rehabilitation | Pain Medicine | 01052338A | INDIANA | No |
| 4 | 2081P2900X | Physical Medicine & Rehabilitation | Pain Medicine | ME 100056 | FLORIDA | No |
| 5 | 208100000X | Physical Medicine & Rehabilitation | | MD R8G18 | MISSOURI | No |
| 6 | 2081P2900X | Physical Medicine & Rehabilitation | Pain Medicine | MD.29617 | ALABAMA | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 4412474 | OTHER | OHIO | AETNA PROVIDER NUMBER |
| 2 | KO0626913 | MEDICARE PIN | OHIO | |
| 3 | KO0626911 | MEDICARE PIN | OHIO | |
| 4 | BV248Z | MEDICARE PIN | FLORIDA | |
| 5 | 000002959 | MEDICARE PIN | MISSOURI | |
| 6 | 16250 | OTHER | FLORIDA | BLUE CROSS BLUE SHIELD OF FLORIDA |
| 7 | 12519002 | OTHER | OHIO | UNITED HEALTHCARE |
| 8 | 12519002 | OTHER | FLORIDA | UNITED HEALTHCARE |
| 9 | 0739106 | MEDICAID | OHIO | |
| 10 | KO0626912 | MEDICARE PIN | OHIO | |
| 11 | 43145208700 | OTHER | OHIO | OH WORKERS' COMP |
| 12 | KO0626914 | MEDICARE PIN | OHIO | |
| 13 | 111544 | MEDICAID | ALABAMA | |
| 14 | 060005763 | OTHER | OHIO | RAIL ROAD MEDICARE NUMBER |
| 15 | 51049505 | OTHER | ALABAMA | BLUE CROSS BLUE SHIELD OF ALABAMA |
| 16 | A10507 | MEDICARE UPIN | OHIO | |
| 17 | 000000033788 | OTHER | OHIO | ANTHEM PROVIDER NUMBER |
| 18 | ME100056 | OTHER | FLORIDA | FL WORKERS' COMP |
| 19 | 102I259941 | MEDICARE PIN | ALABAMA | |
